Article: High hepatitis B surface antigen levels predict insignificant fibrosis in hepatitis B e antigen positive chronic hepatitis B

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Publisher Website: 10.1371/journal.pone.0043087
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PMID: 22916211

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Title	High hepatitis B surface antigen levels predict insignificant fibrosis in hepatitis B e antigen positive chronic hepatitis B
Authors	Seto, WK1 Wong, DKH1 Fung, J1 Ip, PPC1 Yuen, JCH Hung, IFN1 Lai, CL1 Yuen, MF1
Keywords	Accuracy Alanine aminotransferase blood level Diagnostic test accuracy study Disease severity Hepatitis B
Issue Date	2012
Publisher	Public Library of Science. The Journal's web site is located at http://www.plosone.org/home.action
Citation	PLoS One, 2012, v. 7 n. 8, article no. e43087 [How to Cite?] DOI: http://dx.doi.org/10.1371/journal.pone.0043087
Abstract	INTRODUCTION: There is no data on the relationship between hepatitis B surface antigen (HBsAg) levels and liver fibrosis in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B (CHB). METHODS: Serum HBsAg and HBV DNA levels in HBeAg-positive CHB patients with liver biopsies were analyzed. The upper limit of normal (ULN) of alanine aminotransferase (ALT) was 30 and 19 U/L for men and women respectively. Histologic assessment was based on Ishak fibrosis staging for fibrosis and Knodell histologic activity index (HAI) for necroinflammation. RESULTS: 140 patients (65% male, median age 32.7 years) were recruited. 56 (40%) had ALT </=2xULN. 72 (51.4%) and 42 (30%) had fibrosis score </= 1 and necroinflammation grading </= 4 respectively. Patients with fibrosis score </= 1, when compared to patients with fibrosis score >1, had significantly higher median HBsAg levels (50,320 and 7,820 IU/mL respectively, p<0.001). Among patients with ALT </=2xULN, serum HBsAg levels achieved an area under receiver operating characteristic curve of 0.869 in predicting fibrosis score </= 1. HBsAg levels did not accurately predict necroinflammation score. HBsAg >/= 25,000 IU/mL was independently associated with fibrosis score </= 1 (p=0.025, odds ratio 9.042).Using this cut-off HBsAg level in patients with ALT </=2xULN, positive and negative predictive values for predicting fibrosis score </= 1 were 92.7% and 60.0% respectively. HBV DNA levels had no association with liver histology. CONCLUSION: Among HBeAg-positive patients with ALT </=2xULN, high serum HBsAg levels can accurately predict fibrosis score </= 1, and could potentially influence decisions concerning treatment commencement and reduce the need for liver biopsy.
ISSN	1932-6203 2011 Impact Factor: 4.092 2011 SCImago Journal Rankings: 0.519
DOI	http://dx.doi.org/10.1371/journal.pone.0043087
PubMed Central ID	PMC3423440
References	References in Scopus

DC Field	Value
dc.contributor.author	Seto, WK
dc.contributor.author	Wong, DKH
dc.contributor.author	Fung, J
dc.contributor.author	Ip, PPC
dc.contributor.author	Yuen, JCH
dc.contributor.author	Hung, IFN
dc.contributor.author	Lai, CL
dc.contributor.author	Yuen, MF
dc.date.accessioned	2012-09-20T07:57:58Z
dc.date.available	2012-09-20T07:57:58Z
dc.date.issued	2012
dc.description.abstract	INTRODUCTION: There is no data on the relationship between hepatitis B surface antigen (HBsAg) levels and liver fibrosis in hepatitis B e antigen (HBeAg)-positive patients with chronic hepatitis B (CHB). METHODS: Serum HBsAg and HBV DNA levels in HBeAg-positive CHB patients with liver biopsies were analyzed. The upper limit of normal (ULN) of alanine aminotransferase (ALT) was 30 and 19 U/L for men and women respectively. Histologic assessment was based on Ishak fibrosis staging for fibrosis and Knodell histologic activity index (HAI) for necroinflammation. RESULTS: 140 patients (65% male, median age 32.7 years) were recruited. 56 (40%) had ALT </=2xULN. 72 (51.4%) and 42 (30%) had fibrosis score </= 1 and necroinflammation grading </= 4 respectively. Patients with fibrosis score </= 1, when compared to patients with fibrosis score >1, had significantly higher median HBsAg levels (50,320 and 7,820 IU/mL respectively, p<0.001). Among patients with ALT </=2xULN, serum HBsAg levels achieved an area under receiver operating characteristic curve of 0.869 in predicting fibrosis score </= 1. HBsAg levels did not accurately predict necroinflammation score. HBsAg >/= 25,000 IU/mL was independently associated with fibrosis score </= 1 (p=0.025, odds ratio 9.042).Using this cut-off HBsAg level in patients with ALT </=2xULN, positive and negative predictive values for predicting fibrosis score </= 1 were 92.7% and 60.0% respectively. HBV DNA levels had no association with liver histology. CONCLUSION: Among HBeAg-positive patients with ALT </=2xULN, high serum HBsAg levels can accurately predict fibrosis score </= 1, and could potentially influence decisions concerning treatment commencement and reduce the need for liver biopsy.
dc.description.nature	published_or_final_version
dc.identifier.citation	PLoS One, 2012, v. 7 n. 8, article no. e43087 [How to Cite?] DOI: http://dx.doi.org/10.1371/journal.pone.0043087
dc.identifier.doi	http://dx.doi.org/10.1371/journal.pone.0043087
dc.identifier.hkuros	208878
dc.identifier.issn	1932-6203 2011 Impact Factor: 4.092 2011 SCImago Journal Rankings: 0.519
dc.identifier.issue	8, article no. e43087
dc.identifier.pmcid	PMC3423440
dc.identifier.pmid	22916211
dc.identifier.scopus	eid_2-s2.0-84865176357
dc.identifier.uri	http://hdl.handle.net/10722/164323
dc.identifier.volume	7
dc.language	eng
dc.publisher	Public Library of Science. The Journal's web site is located at http://www.plosone.org/home.action
dc.publisher.place	United States
dc.relation.ispartof	PLoS One
dc.relation.references	References in Scopus
dc.rights	Creative Commons: Attribution 3.0 Hong Kong License
dc.subject	Accuracy
dc.subject	Alanine aminotransferase blood level
dc.subject	Diagnostic test accuracy study
dc.subject	Disease severity
dc.subject	Hepatitis B
dc.title	High hepatitis B surface antigen levels predict insignificant fibrosis in hepatitis B e antigen positive chronic hepatitis B
dc.type	Article

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Author Affiliations

The University of Hong Kong